A case of brucellosis admitting with bleeding

Abstract

During the course of an acute brucellosis infection, severe thrombocytopenia, ITP and bleeding are rarely seen and can be misleading for hematological diseases. Our case was a 20-year-old male patient. He had admitted to the Emergency Room with the complaints of gingival bleeding and bleeding of his pimples. His platelet count was 1.6 x 10³ /µL and he was hospitalized with the preliminary diagnoses of ITP or hematological malignancy. Despite steroids and IV immunoglobulin treatment, his thrombocytopenia did not improve and he further developed melena. A bone marrow biopsy was planned. No significant pathology was detected in the examination of bone marrow aspiration. Brucella tube agglutination test had been ordered to identify the etiology of thrombocytopenia. Its result was reported as 1/160 (+) leading to an hemoculture. The hemoculture resulted in the growth of Brucella mellitensis. Therefore the patient was diagnosed as Brucellosis. Steroid has stopped, with the administration of antimicrobial treatment, his platelet count started improving from second day onwards. All his hemotological findings improved with this treatment. The fact that the patient had findings of severe thrombocytopenia and bleeding resulted in considering a preliminary diagnosis of hematological malignancy. In our country which is endemic for Brucellosis, the differential diagnosis of several patients admitting with different hematological presentations should definitely include Brucella.